August 5, 2004
Volume 48, Issue 29
2005 Annual Convention: Leadership in an Era of Transparency
-- Brochure & registration form included in this week's Packet
Make plans to attend the 2005 WHA Annual Convention, scheduled September 21-23 at the Kalahari Resort in Wisconsin Dells.
A strong line-up of presentations will bring the 2005 theme of "Health Care Leadership in an Era of Transparency" to life. This year's convention begins with Dr. Jim Reinertsen, senior fellow for the Institute for Healthcare Improvement, president of The Reinertsen Group and former hospital CEO, discussing the changes and challenges of successful health care leaders in this era of transparency. Thursday afternoon is devoted to the topic of community benefits, with an update from WHA's Task Force on Community Benefits, a "lessons learned" presentation by an Illinois hospital that recently lost its tax-exempt status, and a panel highlighting some of Wisconsin hospitals' most innovative community benefit activities.
Join us Friday morning for an entertaining look ahead at our health care culture by Dr. Kent Bottles, an innovative health care futurist. The convention will close with an optional one credit, Category I ACHE program, offered by the Wisconsin Chapter of ACHE, focused on medical staff relations.
Hospital administrators, chief financial officers, management staff, nurse leaders, physicians, and trustees are encouraged to attend the WHA Convention. The 2005 convention is submitted for 7 long-term care administration continuing education credits, and for 7 ACHE category II (non-ACHE) credits. Additionally, the Wisconsin Medical Society designates this education activity for a maximum of 7 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spends in the activity.
The full conference brochure, with registration information, is included in this week's packet and is available on-line at www.wha.org . For more information on the program content, contact Jennifer Frank at 608-274-1820 or email jfrank@wha.org . For registration questions, contact Sherry Rabuck at 608-274-1820 or email srabuck@wha.org .
President Bush Signs Patient Safety and Quality Improvement Act
On August 1, 2005, President Bush signed into law the Patient Safety and Quality Improvement Act (S.544), putting in motion the ability for health care organizations to share patient safety information without fear of subsequent lawsuits. The bill provides legal and confidentiality protections to health care organizations and workers that report patient care errors for educational purposes. The bill encourages private and public entities to create "patient safety organizations" to carry out specified patient safety activities. These patient safety activities can include:
??Collection and analysis of patient safety data ??Development and dissemination of information to improve safety, such as protocols and best practices ??Utilization of patient safety work products to create a culture of safety and provide feedback to minimize patient risk
Patient level information may be collected by the patient safety organization under the rules of HIPAA. Patient safety information that is identifiable at the organizational level will also be protected from disclosure except where it is required by federal, state or local law. Participation in a qualified patient safety organization will be voluntary.
"This is important legislation that has the potential for further advancing patient safety improvement initiatives," said WHA President Steve Brenton. "WHA will carefully review the potential of using this new federal law as a component of our current and future quality and safety improvement strategies."
The new federal law, despite its protections, does not address a number of state level peer review issues. WHA is working with members to seek improvements to Wisconsin's peer review statute that will further support quality and safety initiatives in Wisconsin.
For additional information, contact Dana Richardson at drichardson@wha.org or 608-274-1820.
Contributions Continue to Climb
Combined contributions to Wisconsin Hospitals Political Action Funds and AHA PAC now exceed $127,000. That total accounts for 73 percent of the 2005 goal to raise $175,000. Individuals from 58 Wisconsin hospitals and health systems have recognized the importance of supporting this year's campaign. However, according to WHA President Steve Brenton, "that also means that individuals from well over half of Wisconsin hospitals have not yet taken the opportunity to support these funds which invest in elections of lawmakers who make immensely important decisions regarding how Wisconsin hospitals are funded, regulated and operated."
Aggregate individual totals can be found at the end of this newsletter recognizing contributors who understand the importance of political contributions in the advocacy process. WHA VP, Government Affairs Jodi Bloch extends her appreciation for their efforts. "I want to thank all who have stepped up to the plate by making a contribution, especially first time contributors. Without this support, we can't help elect officials who understand and support our mission."
To find out more information about Wisconsin Hospitals PAC, Conduit or AHAPAC, contact Jodi Bloch or Jenny Boese at 608-274-1820.
An updated report on health care cost trends has been developed by George Quinn, senior vice president at WHA, and posted on WHA's popular Toolkit at wha.org. The report, available in a PowerPoint format, includes the latest data on premium costs, hospital and physician services utilization and prescription drug utilization. The report also highlights health care cost drivers and opportunities for improvement.
A second addition to the Toolkit relates to issues of medical liability. This section includes resources and information on court cases impacting Wisconsin's liability environment, such as Ferdon, which found Wisconsin's cap on non-economic damages unconstitutional.
Find these publications and more, online at www.wha.org/toolKit/default.aspx.
[This Guest Column from WHA Board Member Mike Schafer is an edited e-mail communication to his state legislators regarding Governor Doyle's Medicaid vetoes.]
Senator Jauch and Representative Hubler,
I am writing to you, as my elected representatives, to voice my frustration and outrage with Governor Doyle's vetoes of the minuscule provider increases to Medical Assistance Reimbursement.
The 1.4% increase in nursing home reimbursement that was included in the Joint Finance Committee's budget and passed on a bipartisan, unanimous vote would not even come close to covering our increased costs. Yet, it was a recognition that something needs to be done with MA reimbursement.
Hospitals were to receive their first increase in outpatient reimbursement in 10 years! We were hopeful that the state government was finally recognizing the plight we all face. But that was also taken away by the veto pen.
I recognize that K-12 funding is a huge and expensive issue. However, there has to be a way to balance the needs of the poor and the elderly with the needs of our children. The Joint Finance Committee recognized that the MA program cannot survive with the Governor's one-time funding methods such as raiding the Patients Compensation Fund. And thank God that didn't happen with the recent Supreme Court decision regarding the malpractice caps.
The nursing home industry is in a crisis. And most of Wisconsin's rural hospitals own long-term care facilities that provide essential access to our communities' elderly residents. Spooner Health System currently loses approximately $16 per day caring for a Medicaid nursing home resident. We expect that this will grow to nearly $20 a day by the end of this budget cycle. We are fortunate that we can pass on some of these costs to our hospital patients. But how fair is that?
You have both been strong supporters of the health care needs of your constituents as well as area health care providers. We now need you more than ever. We need you to take a leadership role in addressing this problem and helping make Medicaid a priority. I fail to see the reasoning behind expecting health care providers to subsidize a program that the government refuses to adequately fund.
Finally, these vetoes come on the heels of the Wisconsin Supreme Court declaring the medical malpractice caps unconstitutional. This is tragic, as Wisconsin had been considered a malpractice "friendly" state for doctors to practice in. In talking with my colleagues in states that do not have caps, I have been struck by how difficult it is for them to recruit physicians, especially to rural areas. We now face the same recruitment and retention problems they face. I ask that as "fixes" to this problem surface that you support them for the good of your constituents.
Thank you for taking the time to read this. I look forward to discussing these concerns with either of you at any time.
Mike Schafer, FACHE Chief Executive Officer, Spooner Health System
Damage Caps, Medicaid Top Public Policy Council Agenda
The loss of Wisconsin's non-economic damage caps and the future of Medicaid following Governor Doyle's budget vetoes dominated the discussion at an August 2 meeting of WHA's Public Policy Council (PPC). David Olson, CEO of Bay Area Medical Center, presided over the meeting.
WHA's Eric Borgerding briefed the Council on the final outcomes in the state budget. Borgerding noted significant gains in Graduate Medical Education (GME) funding of $12.5 million, and an $11.6 million increase in outpatient hospital payments. Unfortunately, and as reported in the July 29 issue of Valued Voice, the outpatient increase was vetoed by Governor Doyle. Through vetoes, the Governor also created a $61 million deficit in Medicaid that will surely come back to haunt the program in the coming months. Borgerding described next steps, including possible veto overrides and opportunities to revisit Medicaid in a spring budget adjustment bill.
With that in mind, WHA President Steve Brenton indicated that WHA will soon reconvene its Medicaid Task Force to begin grappling with ongoing and pressing Medicaid issues, including proposals to address the growing needs of hospitals that serve disproportionate shares of Medicaid and uninsured patients.
"There is a great deal of interest, particularly from some Republican members of the Joint Finance Committee, in developing solutions to this emerging crisis," Brenton said. "WHA is anxious to work with them to find solutions."
The bulk of the meeting was devoted to the Wisconsin Supreme Court's decision to overturn the state's cap on non-economic damages, and other recent harmful decisions (see July 15 issue of Valued Voice). WHA General Counsel Laura Leitch described the Court's ruling and speculated as to what may be acceptable (to the court) legislative solutions.
"We need to move forward quickly with legislation that is solely focused on restoring the cap on non-economic damages; that is the reality," Borgerding said. "The make-up of the court, speculation about what will or will not be found constitutional in the future, the desire to address broader aspects of liability reform, and various other unknowns are all important, but idle speculation if we can't get a bill passed through the Legislature and signed by the Governor. Getting a bill signed into law that restores the caps is WHA's top priority."
Guest speakers James Buchen, VP of Government Affairs, Wisconsin Manufacturers & Commerce (WMC) and Jim Pugh, WMC's Director of Communications, joined the discussion. Buchen described several other recent Wisconsin Supreme Court decisions (lead paint, Miller Park), in addition to the repeal of the caps, that will have a very damaging impact on the state's business climate.
"Taken together, (Ferdon, Miller Park, and lead paint), it is a major setback in the business environment for those companies looking to relocate to Wisconsin," Buchen said. Buchen also raised the broader issue of the current Supreme Court and how it appears to be using its power to essentially rewrite legislation it simply does not agree with, or "legislate from the bench" - a concern shared by WHA.
"There exists an uneasy truce among the three branches, and the Legislature feels their authority was trampled on when the Supreme Court established a different standard of review in the Ferdon case (damage caps)," Buchen said. "We have to find a way to reestablish the balance of power between the legislative, executive and judicial branches and address what is clearly becoming an activist court. That may be accomplished through legislation, an amendment to the state constitution, or both."
The rest of the Council's burgeoning agenda included: an update on the WHA Board planning session and WHA's Community Benefits Task Force; a summary and discussion of several pieces of pending legislation; a status report on the Wisconsin Hospitals PAC/Conduit (see related article on page 2); and a description of WHA's post-budget legislative agenda.
The next meeting of the Public Policy Council will be on November 8.
JCAHO Agrees to Accept Certain Modifications to the 2006 Accreditation Survey Contract
AHA and the state hospital associations have been working with JCAHO to address specific hospital concerns with the 2006 JCAHO Accreditation Survey Contract and Business Associate Agreement Addendum. AHA is hopeful that at the end of this process with JCAHO, all accredited hospitals will receive potential amending language to address specific contractual concerns raised by hospitals.
AHA provided all hospitals with a Quality Advisory describing the contractual modifications that JCAHO has agreed to accept and how hospitals, including those that already have signed and returned their 2006 Accreditation Contract, can incorporate appropriate amendments into their JCAHO agreements. A copy of the AHA advisory is available on WHA's Web site under Legal and Regulatory.
2004 Annual Survey and Fiscal Survey Data Sets Available August 12
Beginning August 12, WHA Information Center, the respected source for Wisconsin hospital and ambulatory surgery data, will have the 2004 Annual Survey and Fiscal Survey data sets available for purchase. These comprehensive surveys detail information about hospital staffing, services and finances.
The following information is included in the fiscal survey data set:
The hospital data set contains the following:
For information about purchasing these or any of the many other data sets available from WHA Information Center, call 800-231-8340 or email whainfocenter@wha.org .
CMS Releases Final Inpatient Rule for 2006
The Centers for Medicare and Medicaid Services (CMS) has released the final Medicare Inpatient Prospective Payment System rule for Federal Fiscal Year (FFY) 2006. CMS responded favorably to comments on some issues, making improvements in the market basket update, CAH relocation issue, and the outlier threshold. Unfortunately, the final rule still includes a substantial expansion of the post-acute transfer policy. Major provisions include:
- Market basket: CMS has increased the FFY 2006 market basket update from 3.2 percent in the proposed rule to 3.7 percent in the final rule. The CMS action was in response to comments from WHA and others urging CMS to review the market basket projection methodology. The comments were based on an analysis showing that the projected market basket has been consistently and materially lower than the actual increase in recent years.
- Update factor: The rule provides a full market basket update for hospitals that submit quality data as part of the Hospital Quality Alliance. Hospitals that fail to submit the necessary data will receive the marketbasket increase minus 0.4 percent. Hospitals will also be required to pass a chart audit validation test to receive the full update for FFY 2006.
- Expansion of post-acute care transfers: In response to comments, CMS revised the proposed criteria for selecting DRGs for this policy. However, the revised criteria still result in a radical expansion of the post-acute transfer policy. Currently, patients in 30 Diagnosis Related Groups (DRGs) are paid as transfers if they are discharged to a post-acute care setting. CMS had proposed expansion to 231 DRGS. The final rule extends this policy to 182 DRGs in FFY 2006.
- CAH Relocation Fix: The final rule defines how a Critical Access Hospital (CAH) that was designated by a State as a "necessary provider," can retain that status after relocating its facility. The Medicare Modernization Act of 2003 eliminated the authority of states to designate CAHs as "necessary providers." This designation allowed a CAH to be situated less than 35 miles from the nearest hospital. However, the MMA did not specify how existing CAHs with necessary provider status should be treated if they relocate. In response to comments from WHA and others, CMS is allowing a necessary provider CAH to relocate if the facility in its new location meets all three of the "75-percent" criteria. That is, 75 percent of the patients must come from the same service area as before the relocation; 75 percent of the services must be the same as at the prior facility; and 75 percent of the staff must be the same as at the prior facility. CMS did not adopt provisions in the proposed rule that would have set a date by which a CAH must notify CMS of its intent to relocate or would have required that construction plans were under way prior to the enactment of the MMA.
- Outliers: CMS will decrease the outlier threshold from $25,800 in FFY 2005 to $23,600 in FFY 2006. As a result, it will be easier for hospitals to qualify for outlier payments. CMS had proposed an increase in the threshold for FFY 2006, but responded to comments from WHA and others noting a shortfall in FFY 2004 and FFY 2005 payments compared to the 5.1 percent outlier payment target.
- Decrease in the labor share of the rate: CMS will decrease the portion of the rate that is adjusted by the wage index from 71.1 percent in FFY 2005 to 69.7 percent in FFY 2006. This reduction will decrease payments for all hospitals with a wage index over 1.0. The labor share for hospitals with a wage index less than or equal to 1.0 is set by law at 62% and this will not change.
- Wage index: In FFY 2006, hospitals will receive 100 percent of the wage index based on the new wage area definitions. As proposed, CMS is terminating the transition provided in FFY 2005 for hospitals whose wage index decreased due to the implementation of the revised labor markets.
- Continuation of the 10 % blend for the occupational mix adjustment: In FFY 2005, CMS calculated wage indexes using a blend of 10 percent of the wage data adjusted for occupational mix and 90 percent of the data unadjusted for occupational mix. CMS will continue this 10 percent blend in FFY 2006.
CMS notes that the federal District Court decision in Bellevue Hospital Center v. Leavitt requires full implementation of the occupational mix adjustment for the plaintiffs. However, CMS will continue the existing policy pending an appeal.
- Cardiac DRG Changes: The final rule also revises nine cardiovascular surgery DRGs that account for over 700,000 Medicare discharges per year. In response to public comment and consistent with recommendations by the Medicare Payment Advisory Commission (MedPAC), CMS is making these revisions so Medicare's payments better recognize severity of illness. The changes announced in the final rule will differentiate cardiac surgery patients based on whether they have a "major cardiovascular condition." The changes represent a significant improvement in accuracy of the cardiac DRGs. As CMS noted in its report to Congress on specialty hospitals in May, CMS is completing a comprehensive analysis of potential changes in cardiac DRGs as recommended by MedPAC and others for implementation by FY 2007.
The final rule is scheduled for publication in the August 12 Federal Register. A copy of the rule is available at www.cms.hhs.gov/providers/hipps/cms-1500f.pdf.
Proposed Rule Updates Medicare Payment Rates for Physicians
The Centers for Medicare & Medicaid Services this week released its proposed rule updating Medicare payment rates and policies for physicians in 2006. The rule would reduce the payment rate per service by 4.3 percent, as required by a statutory formula that takes into account growth in overall Medicare spending in 2004, and would revise a number of other policies affecting Medicare Part B payments. For instance, it revises payment for separately billable drugs and biologicals furnished by End Stage Renal Disease facilities, and will change the drug add-on adjustment established to account for the difference between previous payments and the revised pricing that took effect January 1, 2005. CMS also is seeking comment on an appropriate dispensing fee amount for inhalation drugs provided using nebulizers, which are covered by Medicare Part B for 2006. The proposed rule will be published in the August 8, 2005 Federal Register, with comments accepted until September 30.
On September 22, WHA and the Healthcare Attorneys of Wisconsin will present the program "Addressing Legal Challenges Facing Wisconsin Hospitals." The program will be offered concurrently with the WHA Annual Convention. This program will focus on new legal developments facing hospitals around the country and more recently in Wisconsin, and will address matters such as the outlook for class action cases, the relationship between the charity care controversy and corporate campaigns, the role of government in the billing and uninsured patient setting, and the potential for enforcement actions and denial of property tax exemption.
Anyone interested in learning more about the variety of new legal challenges currently facing non-profit hospitals is encouraged to attend including, legal counsel, chief executive officers, chief financial officers, chief operating officers, compliance officers, risk managers, and business development officers.
This program will be offered concurrently with the WHA Annual Convention on September 22, 2005 from 9 am to 4:30 pm at the Kalahari Resort in Wisconsin Dells. A brochure with registration form is included in this week's packet, and is available online at www.wha.org .
For more information on the program content, contact Laura Leitch or Matthew Stanford at 608-274-1820 or email lleitch@wha.org or mstanford@wha.org . For registration questions, contact Sherry Rabuck at 608-274-1820 or email srabuck@wha.org .
The Centers for Medicare & Medicare Services has released its final rule for the inpatient rehabilitation facility prospective payment system in fiscal year 2006. The rule, which will appear in the Aug. 15 Federal Register, is very similar to the proposed rule issued in May. It provides a full market basket update of 3.6 percent, reduces the outlier threshold to $5,132 from $11,211, and increases the adjustment for rural providers to 21.3 percent from 19.14 percent. It also includes a new adjustment for IRFs designated as teaching facilities, a one-year phase-in of new labor market definitions used to adjust for geographic wage differences, and a 1.9 percent across-the-board reduction to all IRF payment categories, known as case mix groups. CMS estimates the rule will result in a 3.4 percent increase in Medicare payments for IRFs, but noted that some facilities will receive lower payments than they did in 2005. CMS Backs Off of CAH Relocation Ban
The Centers for Medicare and Medicaid Services (CMS) has released its final Medicare inpatient payment rule. The final regulation drops the proposed Critical Access Hospital (CAH) relocation ban that had been the subject of much congressional opposition over the past six weeks.
In its place, CMS is proposing that Critical Access Hospitals be allowed to relocate provided that the facilities meet three "75 percent" criteria. That is: 75 percent of patients must come from the same service area as before the relocation, 75 percent of the hospital services must be the same as at the prior facility, and 75 percent of the hospital staff must be the same as at the prior facility.
"This is an important win for rural health care," said WHA President Steve Brenton. "And members of the Wisconsin Congressional Delegation were instrumental in overturning this onerous idea." Brenton noted that Representatives Ron Kind (D-La Crosse), Paul Ryan (R-Janesville), Mark Green (R-Green Bay), and Tammy Baldwin (D-Madison) had been particularly helpful in raising objections to the CAH relocation ban.
Wisconsin hospitals that were potentially affected by the proposed regulation included: Ladd Memorial Hospital, Osceola; St. Joseph's Community Health Services, Hillsboro; and Memorial Community Hospital, Edgerton. Brenton suggested that all three facilities, along with other Wisconsin hospitals that might look at future relocations, should have no trouble complying with the 75 percent criteria.
Governor's Oral Health Task Force Issues Report
There is a dire need for people, especially children, who are either uninsured or covered by the Medicaid/BadgerCare program, to be able to access oral health and dental services. For this reason, Governor Doyle created a task force comprised of dental hygienists, dentists, oral health vendors, health care providers, legislators, and public health officials. This Task Force to Improve Access to Oral Health was charged with five objectives:
WHA will be looking for ways to work with the Governor's office as well as with the State Legislature in implementing many of the Task Force's recommendations. WHA is on record as supporting independent practice and scope of practice for dental hygienists, as well as moderate increases in T-19 payments to dentists who provide oral health services to a disproportionate share of T-19 patients. For a copy of the complete report, go to WHA's Web site at www.wha.org/qualityAndPatientSafety/pdf/oralhealth7-05.pdf. If you have any specific questions, contact Bill Bazan at 414-431-0105 or bbazan@mailbag.com .
WMC Develops Healthcare Data Guide to Help Employers Find Information
Speaking at the WHA Board Planning Session on July 21, Jim Haney, president of Manufacturers and Commerce, emphasized the need for improved dialogue between employers and employees on the subject of health care. For an employer, starting that conversation can seem like a daunting task. To help their members become familiar with the various resources that are now available, WMC developed a flyer that showcases what they call the "top resources providing health care data than can assist Wisconsin businesses and their employees make informed health care decisions."
The resources they singled out were:
www.healthclickwisconsin.org: Simplifies your search for information on the quality, safety and service provided by Wisconsin's medical clinics and hospitals.
www.wiqualitycollaborative.org: Provides public reporting of quality measure for 40+ hospitals.
www.wipricepoint.org: Provides health care consumers access to basic, facility-specific comparative information about hospital charges.
www.wicheckpoint.org: Provides reliable, valid measures of quality and error prevention practices to aid purchasers in the selection of quality health care.
"If employees use employer-provided resources, such as CheckPoint and PricePoint, significantly more will report good consumer behavior over those that do not use these tools," Haney said.
A copy of WMC's flyer is in this Packet and is posted at www.wmc.org/PDFfiles/HealthcareData.pdf
WHA recently completed a review of all Wisconsin hospital Web sites looking for a couple of links - one to CheckPoint or healthclickwisconsin.org, and another to PricePoint. The "point?" Since WHA members embarked on what has become known as one of the most aggressive voluntary transparency agendas in the country, WHA staff wanted to know if the information is easy to access through hospital and health system Web sites.
The results were mostly positive-about half of the hospital Web sites had links to CheckPoint, healthclickwisconsin.org, and/or PricePoint. Some had entire pages devoted to quality and safety, and they included a link to PricePoint.
Encourage your Webmaster to add a link to CheckPoint and PricePoint. If your hospital reports to both CheckPoint and to the Wisconsin Collaborative for Healthcare Quality, you are encouraged to use the healthclickwisconsin.org link, as it is a portal to both CheckPoint and WCHQ reports.
The icons for all of the above links can be found on WHA's homepage at www.wha.org. Right click on the icons to copy them to your Web site. If you have questions related to downloading the icons or what hyperlinks to use from the icons, contact Tammy Hribar at thribar@wha.org or 608-274-1820.
Complete Case Summary of Ferdon Decision Included in this Week's Packet.
Look in this week's Friday Packet for General Memo 3-05 - "Analysis of Recent Supreme Court Cases" that contains case summaries prepared by WHA of recent Wisconsin Supreme Court decisions affecting health care, including Ferdon v. Wisconsin Patients Compensation Fund, that overturned Wisconsin's non-economic damage cap.
National Study Evaluates Hospital Performance Based on Quality Measures
A recent study, Care in U.S. Hospitals - The Hospital Quality Alliance Program, provides one of the first glimpses of the quality of care provided by hospitals across the United States based on standardized measures. In an article authored by Ashish K. Jha, MD, et al, the authors evaluated the results of the 10 clinical measures related to acute heart attack, congestive heart failure and pneumonia care submitted to the Hospital Quality Alliance to answer the following questions.
1. How well do hospitals perform on the basis of these quality measures? The quality of care in hospitals that reported at least one stable measure (defined as at least 25 cases) was higher on 9 of 10 measures compared to hospitals that reported no stable measures. The quality of care in the hospitals that reported at least one stable measure varied by mean score between 43 percent to 98 percent across the 10 measures, with the highest quality of care provided to patients treated for an acute heart attack.
2. How variable is performance across regions? Using the referral regions defined by the Dartmouth Atlas of Health Care, the authors compared the mean score for the top 40 referral regions by volume. This analysis indicated that there is a substantial gap (12-23 percentage points) in mean performance between the top performing referral region and the lowest performing referral region for all three conditions.
In addition, a moderate correlation was identified between the performance of a hospital referral region with respect to acute heart attack and its performance on congestive heart failure care (R=0.72, P<0.001), a lower correlation between acute heart attack and pneumonia care (R=0.45, P=0.004) and an even lower correlation between congestive heart failure and pneumonia care (R=0.15, P=0.35).
Note: The top 40 referral regions by volume did not include any Wisconsin regions.
3. What is the likelihood that a high level of performance in one condition predicts a high level of performance in other conditions? To evaluate performance between clinical conditions, the authors identified hospitals that were in the top decile of performance score for each condition. Performance scores for acute heart attack closely predicted performance for congestive heart failure, but not pneumonia.
4. Do certain hospital characteristics predict a high level of performance? An evaluation of hospital scores compared to hospital characteristics indicted that academic hospitals had a higher score for acute heart attack and congestive heart failure care (P<0.001), but a lower score on pneumonia care (P=0.02) Not-for-profit hospitals had higher scores for all three conditions than for profit hospitals. Only pneumonia scores were significantly associated with bed size (P=0.001), with the smallest hospitals having the highest scores. Finally, there was a significant regional difference in scores for all three conditions with the Midwest and Northeast outperforming the West and the South.
Conclusion: Analysis of this data shows that performance varies among hospitals and across indicators. Given this variation, the small difference based on hospital characteristics, and the relative lack of correlation in performance across clinical conditions, meaningful performance reporting will need to include several conditions from a broad range of hospitals.
The full text of this study is available through the New England Journal of Medicine 353;3, July 21, 2005 edition.
U.S. House Passes Medical Malpractice Liability Reform Legislation
On Thursday, July 28, the U.S. House of Representatives approved medical malpractice liability reform legislation, HR 5, by a 230-194 vote. Wisconsin's Congressional delegation voted along party lines: Republicans voting in favor (except Sensenbrenner voting "present") and Democrats voting against.
Among the provisions in HR 5, Help Efficient, Accessible, Low-Cost, Timely Healthcare Act of 2005 (HEALTH), are:
??Caps non-economic damages in medical malpractice cases at $250,000. ??Set standards for punitive damage awards. Punitive damages could be awarded only when "clear and convincing" evidence proves that a defendant acted with malicious intent to injure the claimant or deliberately failed to avoid unnecessary injury, and when compensatory damages are awarded. Punitive damages would be limited to the greater of twice economic damages or $250,000. ??Allow courts to restrict the payment of attorney contingency fees based on the size of the award. ??Set a statute of limitations of three years after the date of manifestation of injury or one year after the claimant discovers the injury, with certain exceptions. ??Allow the introduction of collateral source benefits and the amount paid to secure such benefits as evidence. ???Limit the liability of manufacturers, distributors, suppliers, and providers of medical products that comply with Food and Drug Administration standards. ??Provide for periodic payments of future damage awards.
HR 5 will likely encounter a rocky road in the U.S. Senate where passage of liability reform legislation has been much more difficult. At least eight other medical liability reform bills have been stalled in the Senate due to filibusters or threats of a filibuster.
"It is unlikely that we will be able to count on Washington for an answer to the Wisconsin Supreme Court's recent overturning of our non-economic damage caps. That solution must be crafted here, in Wisconsin, by the Legislature and Governor Doyle," said Eric Borgerding, WHA Senior Vice President.
Access information on HR 5 online at THOMAS at http://thomas.loc.gov/ .
Member News: Petasnick Named to AHA Executive Committee
William D. Petasnick, president/CEO of Froedtert & Community Health, Milwaukee, has been named to the American Hospital Association Executive Committee. The Executive Committee is comprised of the chair of the AHA Board of Directors, along with the immediate past chair, chair-elect and four other board members, including the chair of the Operations Committee.
AHA President Dick Davidson said, "Bill has been an outstanding trustee of the AHA. His leadership on the issue of limited service providers and their appropriate role in community health care continues to benefit the entire field. We look forward to his service on the Executive Committee."
AHAPAC, Wisconsin Hospitals PAC and Conduit Contributors
Contributions ranging from $1 - $249
Contributions ranging from $250 - $499
Contributions ranging from $500 - $999
Contributions ranging from $1000 - $1999
Contributions $2000 and above